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PubMed1998

An analysis of test bias and differential item functioning due to race on the Mattis Dementia Rating Scale.

The Mattis Dementia Rating Scale (MDRS) is a commonly used cognitive measure designed to assess the course of decline in progressive dementias. However, little information is available about possible systematic racial bias on the items presented in this test. We investigated race as a potential source of test bias and differential item functioning in 40 pairs of African American and Caucasian dementia patients (N = 80), matched on age, education, and gender. Principal component analysis revealed similar patterns and magnitudes across component loadings for each racial group, indicating no clear evidence of test bias on account of race. Results of an item analysis of the MDRS revealed differential item functioning across groups on only 4 of 36 items, which may potentially be dropped to produce a modified MDRS that may be less sensitive to cultural factors. Given the absence of test bias because of race, the observed racial differences on the total MDRS score are most likely associated with group differences in dementia severity. We conclude that the MDRS shows no appreciable evidence of test bias and minimal differential item functioning (item bias) because of race, suggesting that the MDRS may be used in both African American and Caucasian dementia patients to assess dementia severity.

Aged↗
PubMed2006

Strains of singlehood in later life: do race and gender matter?

OBJECTIVES: Few studies have identified the distinctive aspects of singlehood that are distressing to older adults. The objectives of our study were: (a) to examine whether divorced, widowed, and never-married older adults differed in their experiences of single strain, an indicator of chronic stressors associated with being unmarried; and (b) to assess whether the marital status differences we explored varied by gender and race. METHODS: Using data from a subsample of 530 unmarried older adults and ordinary least squares regression, we estimated main and interactive effects of marital status, gender, and race on single strain. RESULTS: Divorced and widowed persons reported higher single strain than never-married persons, although the magnitude of these effects varied considerably by race and gender. Never-married White women reported higher levels of single strain than their male counterparts. White widows and widowers exhibited higher single strain than widowed Black adults. Black women uniformly fared better than White women, whereas divorced and never-married Black men were not different from their White peers in terms of single strain. DISCUSSION: Psychological adjustment to singlehood among older adults reflects patterns of gender and race stratification and socialization over the life course.

Aged↗
PubMed1984

Thermoregulatory responses to desert heat: age, race and sex.

Sixty-nine whites (38 men and 31 women) aged 17 to 88 years and 48 blacks (19 men and 29 women) aged 17 to 61 years were studied. Each person walked in desert heat for 1 hour at a rate requiring 40% of aerobic capacity. Observations were recorded on their rectal temperature (Tre), skin temperature (Tsk), heart rate (HR), blood pressure, and sweat rate (SR). Older men and women of both races were able to complete their walks without any ill effects. Age, per se, did not significantly reduce elderly individuals' ability to tolerate the combined stress of dry heat and exercise. Men of both races had higher sweat rate and lower heart rate and rectal and skin temperature than women working at the same percentage of aerobic capacity. Success of thermoregulation at 40% of aerobic capacity of blacks and whites was equal, but in both races men thermoregulated more successful than women. Our data suggest that thermoregulatory capacity of humans under desert conditions differs between sexes and is not influenced significantly by age or race except for differences in aerobic capacity.

Adolescent↗
PubMed1991

Race and the self-reported health of elderly persons.

This research examined race differences in the structure and measurement of six self-reports of health that are widely used in studies of elderly persons. Second-order confirmatory factor analyses (LISREL) revealed race differences only in the validity of subjective interpretations of health state and in the measurement error of a chronic conditions indicator. No race differences were found in the form of the four-factor model of self-reported health. Results, interpreted within a cognitive illness-labeling framework, have implications for future race-comparative health research.

Activities of Daily Living↗
PubMed1994

Gender, race, and health: the structure of health status among older adults.

A previously developed model of disease, disability, functional limitation, and perceived health was examined for race and/or gender biases. This model focuses on (a) the direct effects of three factors on perceived health status, (b) how disability, functional limitations, and self-rated health interrelate, and (c) how race and gender condition these interrelationships. The results confirm the construct validity of separate dimensions of disability and functional limitation, and indicate that their differential effects are further modified by gender. Eight significant differences in structural effects are identified, including one gender effect among both blacks and whites, and seven additional gender effects among whites. In the structural model, then, most differences are gender differences among whites. The significant racial differences within gender were found only in the measurement model. Race differences for upper body disability and perceived health are consistent across gender. Sex differences, however, in measures of basic ADLs and household ADLs are not consistent across race. The findings confirm earlier conclusions that differences in the measurement of health exist between males and females, and between blacks and whites, but that the differences in the causes of perceived health exist only between males and females.

Aged↗
PubMed2006

Concordance of race or ethnicity of interventionists and caregivers of dementia patients: relationship to attrition and treatment outcomes in the REACH study.

PURPOSE: We assess the effects of racial or ethnic concordance between caregivers and interventionists on caregiver attrition, change in depression, and change in burden in a multisite randomized clinical trial. DESIGN AND METHODS: Family caregivers of patients with Alzheimer's disease were randomized to intervention or control groups at six sites from 1996 to 2000. Interventionists provided psychosocial interventions aimed at decreasing caregiver depression and burden. This analysis included 694 caregivers who received face-to-face interventions from 36 interventionists at five sites. We modeled caregiver loss to follow-up at 12 months and changes in depression and burden from baseline by racial or ethnic concordance by using random effects logistic and linear regression models, controlling for caregiver age, gender, race or ethnicity, relation to care recipient, interventionist race or ethnicity, and care recipient activities of daily living. The loss to follow-up model also controlled for care recipient institutionalization and death. RESULTS: Overall, there was no difference in caregiver loss to follow-up or change in depression or burden by racial or ethnic concordance. African-American caregivers with an interventionist of the same race or ethnicity had greater decreases in depression than did African-American caregivers with interventionists of a different race or ethnicity. However, this finding has to be interpreted cautiously because there were only two African-American interventionists. IMPLICATIONS: Although these initial findings do not provide conclusive evidence on whether racial or ethnic concordance is associated with intervention outcomes for caregivers of Alzheimer's disease patients, these results, along with the paucity of research studies evaluating this issue, suggest that the effects of racial or ethnic concordance in research should be systematically examined in future studies.

Black or African American↗
PubMed2005

Patient satisfaction with health care providers in South Africa: the influences of race and socioeconomic status.

OBJECTIVE: The first democratic government elected in South Africa in 1994 inherited huge inequalities in health status and health provision across all sections of the population. This study set out to assess, 4 years later, the influence of race and socioeconomic status (SES) on perceived quality of care from health care providers. DESIGN: A 1998 countrywide survey of 3820 households assessed many aspects of health care delivery, including levels of satisfaction with health care providers among different segments of South African society. RESULTS: Fifty-one percent (n = 1953) of the respondents had attended a primary care facility in the year preceding the interview and were retained in the analysis. Both race and SES were significant predictors of levels of satisfaction with the services of the health care provider, after adjusting for gender, age, and type of facility visited. White and high SES respondents were about 1.5 times more likely to report excellent service compared with Black and low SES respondents, respectively. CONCLUSION: In South Africa, race and SES are not synonymous and can no longer be considered reliable proxy indicators of one another. Each has distinct and significant but different degrees of association with client satisfaction. Any assessment of equity-driven health policy in South Africa should consider the impacts of both race and SES on client satisfaction as one of the indicators of success.

Adult↗
PubMed2006

A question of blood, race, and politics.

This article explores the political and intellectual context of a controversy arising from a proposal made at the 1959 meetings of the American Society of Blood Banks to divide the blood supply by race. The authors, a group of blood-bankers and surgeons in New York, outlined difficulties in finding compatible blood for transfusion during open-heart surgery, which they attributed to prior sensitization of their patient, a Caucasian, by a previous transfusion from an African American donor. Examining the statistical distribution of blood-group antigens among the various races, they concluded that risk of adverse hemolytic reactions and the cost of testing could be reduced by establishing separate donor pools. The media reported the suggestion, which, given the political climate of the day, rapidly became a public issue involving geneticists, blood-bankers, physical anthropologists, and the African American medical community. Liberals condemned it, whereas eugenically inclined segregationists used the finding to support their views concerning evolutionary distance between the races and the dangers of miscegenation. Here we examine the contribution of comparative racial serology to this affair, the arguments and background of the main players, and the relevance of the debate to discussions about the role of "race" in post-genomic medicine.

Blood Banks↗
PubMed2002

Race, socioeconomic status, and breast cancer treatment and survival.

BACKGROUND: Previous studies have found that African-American women are more likely than white women to have late-stage breast cancer at diagnosis and shortened survival. However, there is considerable controversy as to whether these differences in diagnosis and survival are attributable to race or socioeconomic status. Our goal was to disentangle the influence of race and socioeconomic status on breast cancer stage, treatment, and survival. METHODS: We linked data from the Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER)(1) registry to Michigan Medicaid enrollment files and identified 5719 women diagnosed with breast cancer, of whom 593 were insured by Medicaid. We first calculated the unadjusted odds ratios (ORs) associated with race, Medicaid insurance, and poverty for breast cancer stage at diagnosis, breast cancer treatment, and death. We then estimated the ORs of having late-stage breast cancer at diagnosis, breast-conserving surgery, no surgery, and death using logistic regression after controlling for clinical and nonclinical factors. All statistical tests were two-sided. RESULTS: Before controlling for Medicaid enrollment and poverty, African-American women had a higher likelihood than white women of each unfavorable breast cancer outcome. However, after controlling for covariates, African-American women were not statistically significantly different from white women on most outcomes except for surgical choice. African-American women were more likely than white women to have no surgery (adjusted OR = 1.62; 95% confidence interval [CI] = 1.11 to 2.37). Among women who had surgery, African-American women were more likely to have breast-conserving surgery than were white women (adjusted OR = 1.63; 95% CI = 1.33 to 1.98). CONCLUSIONS: The linkage of Medicaid and SEER data provides more in-depth information on low-income women than has been available in past studies. In our Metropolitan Detroit study population, race was not statistically significantly associated with unfavorable breast cancer outcomes. However, low socioeconomic status was associated with late-stage breast cancer at diagnosis, type of treatment received, and death.

Aged↗
PubMed2005

Changes in women's use of hormones after the Women's Health Initiative estrogen and progestin trial by race, education, and income.

BACKGROUND: We examined the impact of race, education, and household income on changes in rates of discontinuation and initiation of hormone therapy before and after release of the Women's Health Initiative estrogen plus progestin trial results. METHODS: We conducted an observational cohort study of 221 378 women aged 40-80 years enrolled in five health maintenance organizations to estimate the prevalence and rates of discontinuation and initiation of estrogen plus progestin and estrogen only between September 1, 1999, to June 31, 2002 (baseline), and December 31, 2002 (follow-up). We identified the census block group for each participant by geocoding her 2003 residential address. We categorized women into racial, education, and income groups based on the distribution of these characteristics in her community from year 2000 census data and the distributions of these characteristics within her HMO. RESULTS: There were significant differences in estrogen plus progestin and estrogen only prevalence by race, education level, and household income, and in estrogen plus progestin initiation by race and education level, but not by household income at follow-up. However, there were no differences by community race, education, or household income in change in the prevalence of either hormone therapy use at follow-up or in the rates of hormone therapy discontinuation or initiation from baseline to follow-up. CONCLUSIONS: Given the wide spread media attention to the Women's Health Initiative estrogen plus progestin trial results, our findings suggest comparable dissemination of this information across diverse socioeconomic groups.

Adult↗
PubMed2005

Disparities by race in heat-related mortality in four US cities: the role of air conditioning prevalence.

Daily mortality is typically higher on hot days in urban areas, and certain population groups experience disproportionate risk. Air conditioning (AC) has been recommended to mitigate heat-related illness and death. We examined whether AC prevalence explained differing heat-related mortality effects by race. Poisson regression was used to model daily mortality in Chicago, Detroit, Minneapolis, and Pittsburgh. Predictors included natural splines of time (to control seasonal patterns); mean daily apparent temperature on the day of death, and averaged over lags 1-3; barometric pressure; day of week; and a linear term for airborne particles. Separate, city-specific models were fit to death counts stratified by race (Black or White) to derive the percent change in mortality at 29 degrees C, relative to 15 degrees C (lag 0). Next, city-specific effects were regressed on city- and race-specific AC prevalence. Combined effect estimates across all cities were calculated using inverse variance-weighted averages. Prevalence of central AC among Black households was less than half that among White households in all four cities, and deaths among Blacks were more strongly associated with hot temperatures. Central AC prevalence explained some of the differences in heat effects by race, but room-unit AC did not. Efforts to reduce disparities in heat-related mortality should consider access to AC.

Black or African American↗
PubMed2005

Disentangling race and socioeconomic status: a key to understanding health inequalities.

This article addresses one of the most vexing problems facing health disparities researchers, the confounding of race and socioeconomic status. This article does the following: (1) it outlines the magnitude of confounding between race and socioeconomic status; (2) it demonstrates problems caused by this confounding; (3) it examines the degree to which race disparities are a function of socioeconomic status; and (4) it discusses considerations for advancing research on health disparities after accounting for the confounding of race and socioeconomic status.

Adult↗
PubMed1991

Repeated sequence sets in mitochondrial DNA molecules of root knot nematodes (Meloidogyne): nucleotide sequences, genome location and potential for host-race identification.

Within a 7 kb segment of the mtDNA molecule of the root knot nematode, Meloidogyne javanica, that lacks standard mitochondrial genes, are three sets of strictly tandemly arranged, direct repeat sequences: approximately 36 copies of a 102 ntp sequence that contains a TaqI site; 11 copies of a 63 ntp sequence, and 5 copies of an 8 ntp sequence. The 7 kb repeat-containing segment is bounded by putative tRNAasp and tRNAf-met genes and the arrangement of sequences within this segment is: the tRNAasp gene; a unique 1,528 ntp segment that contains two highly stable hairpin-forming sequences; the 102 ntp repeat set; the 8 ntp repeat set; a unique 1,068 ntp segment; the 63 ntp repeat set; and the tRNAf-met gene. The nucleotide sequences of the 102 ntp copies and the 63 ntp copies have been conserved among the species examined. Data from Southern hybridization experiments indicate that 102 ntp and 63 ntp repeats occur in the mtDNAs of three, two and two races of M.incognita, M.hapla and M.arenaria, respectively. Nucleotide sequences of the M.incognita Race-3 102 ntp repeat were found to be either identical or highly similar to those of the M.javanica 102 ntp repeat. Differences in migration distance and number of 102 ntp repeat-containing bands seen in Southern hybridization autoradiographs of restriction-digested mtDNAs of M.javanica and the different host races of M.incognita, M.hapla and M.arenaria are sufficient to distinguish the different host races of each species.

Animals↗
PubMed2005

RACE: Remote Analysis Computation for gene Expression data.

The Remote Analysis Computation for gene Expression data (RACE) suite is a collection of bioinformatics web tools designed for the analysis of DNA microarray data. RACE performs probe-level data preprocessing, extensive quality checks, data visualization and data normalization for Affymetrix GeneChips. In addition, it offers differential expression analysis on normalized expression levels from any array platform. RACE estimates the false discovery rates of lists of potentially regulated genes and provides a Gene Ontology-term analysis tool for GeneChip data to support the biological interpretation and annotation of results. The analysis is fully automated but can be customized by flexible parameter settings. To offer a convenient starting point for subsequent analyses, and to provide maximum transparency, the R scripts used to generate the results can be downloaded along with the output files. RACE is freely available for use at http://race.unil.ch.

Computational Biology↗
PubMed1998

Race and delayed kidney allograft function.

BACKGROUND: Allograft survival among black recipients is poorer than among whites. Delayed allograft function is associated with a significant reduction in renal allograft survival. The relationship between delayed allograft function and black race is incompletely specified and was the focus of this investigation. METHODS: A non-concurrent study of 325 recipients of cadaveric allografts followed for the occurrence of delayed allograft function defined as dialysis during the first week following transplantation for the principal analysis. A secondary definition of delayed allograft function was formulated based on the serum creatinine 2 weeks after transplantation. Unadjusted and adjusted logistic regression analysis were used to examine the unconfounded relationship between race and delayed allograft function. RESULTS: Fifty-seven of 91 (62.6%) black recipients experienced delayed allograft function compared to 113 of 234 (48.3%) whites. The odds ratio for black race as a predictor of delayed allograft function was 1.80, P=0.02, (95% CI, 1.09, 2.95). This finding was stable despite adjustment for other predictors of delayed allograft function in a multivariate model, but the precision of this estimate was less (P=0.10) because of missing data. Additionally, adjusted models with imputed values for missing covariates, models using a secondary definition of delayed allograft function, and models excluding patients whose cyclosporin therapy was delayed, all consistently demonstrated a similar association between black race and delayed allograft function. CONCLUSIONS: This study demonstrated an increased risk of delayed allograft function among black recipients. This relationship may play a role in the poorer allograft outcomes experienced by black recipients. Given the negative effect of delayed allograft function on allograft survival, efforts to identify its modifiable risk factors should be a high priority.

Adult↗
PubMed1992

Socioeconomic factors and race in breast cancer recurrence and survival.

The relation of breast cancer recurrence and overall survival to age, level of estrogen receptors, number of positive lymph nodes, obesity, race, socioeconomic status, and tumor size at the time of diagnosis was considered for 1,392 breast cancer patients (253 black, 1,132 white, and 7 of other races) entered into two multi-institutional prospective clinical trials. Baseline for the first trial was 1974-1979, and that for the second was 1980-1985; follow-up for this report ended in August 1990. Univariately, all factors except age and obesity were significantly related to disease-free survival, and all except age were significantly related to overall survival. A multivariate analysis using Cox's proportional hazards model indicated that a greater number of positive lymph nodes, a larger tumor diameter, lower socioeconomic status, and negative estrogen receptors were significantly related to shorter disease-free survival. After adjustment for socioeconomic status, race ceased to be a significant indicator of either disease-free survival or overall survival. Patients of either race who are of a lower socioeconomic status are more likely to have a recurrence and to die of breast cancer.

Black or African American↗
PubMed1987

Harness racing injuries and deaths. Report of a fatal accident and review of 178 cases.

A case of a harness racing accident in which the driver died of head injuries is presented. To evaluate the victim's head injury and corresponding helmet damage, a videotape of the race was reviewed and analyzed. Based on calculations of a simplified trajectory analysis and testing of the helmet, it was determined that the helmet design did not provide adequate protection for the victim. The standards for harness helmet design are being re-evaluated by the harness racing industry to ensure the safety of the drivers. A review of 178 harness racing injuries and deaths, current harness helmet research, and recommendations for safer helmets are discussed. A protocol for the forensic investigation of sports-related injuries and/or deaths is also presented to assist medical examiners in fulfilling their roles as practitioners of preventive medicine.

Accidents, Occupational↗
PubMed2002

Parathyroid hormone suppression by intravenous calcitriol: role of phosphate, calcium, race and diabetes.

BACKGROUND: Parathyroid hormone (PTH) suppression in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis is achieved largely by the use of intravenous calcitriol. Aspects of the utility and efficacy of this therapy remain controversial. It is debated whether oral versus intravenous therapy is more effective. Most existing studies examine the effect of calcitriol in isolation, without adjusting for other factors that might influence PTH levels. Thus, the simultaneous role of factors such as dosing, control of serum calcium and phosphorus, and demographic variables such as age, sex, race, and duration of ESRD is not well understood. METHODS: We examined the relationship between the administration of calcitriol and PTH suppression in a cohort of hemodialysis patients at a large urban dialysis facility over a period of 30 months. Hemodialysis patients (n = 155) who received at least 3 months of treatment in this facility were included. RESULTS: Using a time sensitive multiple linear regression modeling technique, we found that second and subsequent PTH levels were positively correlated with black race (P < 0.0001) and serum phosphate (P < 0.03) and strongly negatively correlated with serum calcium (P< 0.0001) and diabetes (P< 0.0039). Drug dose (in micrograms per kilogram per month) was weakly negatively correlated (P < 0.04). Unlike previous studies, we adjusted for the simultaneous confounding influence of demographic and laboratory variables, as well as for drug dose normalized for body weight. CONCLUSIONS: This analysis suggests that calcitriol therapy in hemodialysis patients is adversely affected by higher phosphate levels and needs to account for such patient characteristics as race and diabetes and such laboratory variables as calcium and phosphate control. Finally, as has been recently suggested by others, the patient's race may require us to aim for different PTH target levels with therapy.

Algorithms↗